The impact of prehabilitation on surgical outcomes
Bibliographic record
Abstract
Esophageal adenocarcinoma is a particularly challenging and deadly disease. Predominantly affecting older males, the clinical manifestations of the disease include dysphagia, unintentional weight loss, muscle wasting, and persistent functional decline. Due to the aggressive nature of the disease and treatments, patients are at an increased risk for malnutrition, sarcopenia, frailty and postoperative morbidity. Currently, the gold standard for disease management includes perioperative chemo(radio)therapy with esophagectomy, as it confers the greatest curative potential. Though necessary, preoperative anti-cancer therapies impose a significant physiological stress that is poorly tolerated by most patients, resulting in a reduced functional capacity. It can also provoke impairments in physical, nutritional, and psychological status. Despite surgical advancements, esophagectomy remains an invasive procedure associated with a high degree of postoperative morbidity. The disease and treatments adversely impact several determinants of health, and accordingly, an emphasis has been placed on the requisite for multidisciplinary interventions. In an effort to minimize surgical stress, postoperative complications and length of hospital stay, the enhanced recovery after surgery (ERAS) society recently published guidelines for a multidisciplinary approach to perioperative esophagectomy management. Still, postoperative morbidity remains high, therefore highlighting the need for initiatives of broader scope, outside of the surgical setting. The preoperative period represents a window of opportunity for patients to address health deficits and prepare for the stress of esophageal cancer treatments. Prehabilitation describes a multimodal intervention program to optimize a patient’s physical condition preoperatively and minimize the functional declines resultant of cancer treatments. Prehabilitation has been demonstrated to be effective in oncologic surgical candidates to improve functional capacity, postoperative outcomes and rate of recovery. Prehabilitation for esophageal cancer is in its infancy, and to date has not shown any significant impacts on postoperative morbidity. Nevertheless, the few studies published highlight its potential to preserve functional capacity, improve tolerance to the stress of therapies and enhance esophageal cancer care. Still, there is a need for more robust longitudinal studies with larger samples sizes to determine the optimal esophageal prehabilitation prescription and effectively evaluate its impact on both short and long-term outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".